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A bill before Ghana's parliament aims to improve mental health care and encourage more health professionals to enter the sector by tackling one of the greatest impediments to both - stigma.

"Stigma is the top issue affecting the level of care and service," said Peter Yaro, programme manager at Basic Needs, a mental health NGO in Ghana. "Stigma means people don't attach importance to mental health. There is very little prestige in being a psychiatrist or working with people with mental illness."

Ghana has 12 practising psychiatrists for a population of nearly 24 million, and three psychiatric hospitals. All are in the south, with few options for care outside these facilities, said Akwasi Osei, chief psychiatrist in Ghana's national health service.

Stigma also means people can be afraid to work in the field. Noah Atakora Baku, a nurse at Accra Psychiatric Hospital, said another nurse he once encouraged to study mental health, refused "because she had heard that people who study that often have their children affected by mental illness".

Yaro blamed lack of mental health workers and lack of interest by politicians for the current state of Ghana's psychiatric hospitals, which are "overcrowded, with not enough nurses, inadequate human resources. They lack basic logistics, including wheelchairs and beds... they don't have enough personnel and logistics for feeding, or basic medicines, including psychotropic medicines."

Resources are reaching "less than 10 percent of people who need assistance", Yaro said.

Misconceptions about mental illness also lead to inappropriate treatment for the patients who do manage to access hospitals, and in unofficial "prayer camps" aimed at curing mentally ill people. Mental illness is often viewed in supernatural terms "even among professionals", Osei said.

"People have the feeling that if you are a mental patient you are a dangerous person... Currently there are a lot of human rights abuses going on, both within and outside the orthodox facilities," he said. "If you go to prayer camps they put people in chains - that is a human rights abuse. They do so innocently on their part because this is somebody running amuck and they have no way of controlling him than to put him in chains."

Justice, a recovered mental health patient who did not want to give his full name, spent 11 years in an institution without a single visit from family or friends. His father refused to tell his mother and siblings where he was. When he recovered and was taken home by health workers, he found that his father had died four years earlier and the rest of his family - not knowing where he was - had assumed Justice was dead too.

His extended family and community seem to be accepting him now. Though he said sometimes people stare at him and he does not know what they make of him. "I am OK, just that I feel lonely most of the time. You know, I have been far away from my family for a long time - some people I don't seem to remember, but they come to me and talk with me."

Changing attitudes

The draft reforms - developed with support from the World Health Organization - were completed in 2006, but the bill is only now under consideration by parliament. Osei said parliament is expected to take it up again when it reconvenes in October.

The law would address stigma through education and legal protection of patients' rights; it would require the education of workers at mental health facilities, including prayer camps, and close monitoring of facilities, Osei said. "We would train the healers in the prayer camps so they knew their limits. Once we offer the training and support, if they breach the law they can be held responsible."

More generally, public education would be provided through "an active campaign to let everybody know that anybody who suffers from a mental illness should be treated like anybody else who has malaria or any other sickness", said Health Minister Joseph Yieleh Chireh.

The bill would ensure adequate funding for faculties and personnel, he said.

Facilities in need of improvement include Accra Psychiatric Hospital. The psychiatric ward accepts up to 200 patients at a time, but currently has less than 40 beds, Baku said.

Unattractive work

Samuel Paul Odame, a former patient there, said: "If you come to Accra Psychiatric Hospital you see people lying on the bare floor."

These conditions are also responsible for turning off potential staff, Osei said. "If you go to the ward as a young doctor or nurse, you ask yourself: Do I want to work at such a place for the rest of my life?' Because it is not attractive."

As well as improving conditions in hospitals, Osei said the bill would offer more treatment options to patients, largely through an emphasis on care in communities as against the current focus on institutionalized care (which has been in place since a 1972 mental health decree).

While change will take time, Osei said, "if we pass the bill and we take steps to implement it, within five years we will see a new face of mental health in Ghana."

It is also hoped that addressing stigma would make life easier for mentally ill people who can be ostracized by family and friends.

Health Minister Chireh said for recovering patients "reintegration is a problem because of superstition and all the beliefs we [Ghanaians] have about mental sickness."